The Golden Hour Protocol: Implementation of a Quality Improvement Project in a Level II NICU
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Authors
Schnackenberg, Melissa
Issue Date
2022-08-20
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Abstract
Background: It is not unusual for premature infants or infants identified as having very low birth weight (less than 1500 grams) to deliver. Establishment of ventilation and perfusion, appropriate thermoregulation and glucose levels are crucial to protect the brain and neurodevelopment. During the golden hour, the first hour of life, timely interventions aim to improve the infant’s stability and overall outcomes.
Purpose: The purpose of this project was to implement a golden hour protocol for neonates admitted to the neonatal intensive care unit born less than 33 weeks of gestation or identified as having very low birth weight (VLBW) less than 1500 grams.
Methods: Development of the GH protocol included literature review and creating an admission checklist to guide NICU staff in staying organized and efficient in their interventions. The project team conducted a clinical competency day and simulation-based training to educate staff. Practice change was guided by the Stevens Star Model of Knowledge Transformation. Evaluation was done by comparing the timing of admission interventions to include: time to initiation of venous nutrition and antibiotics, time to first axillary temperature and glucose level, and time to closure of isolette top representing completion of admission.
Findings/Results: Data were collected on 14 neonates pre-implementation and 10 neonates post-implementation of this project. The average admission time pre-protocol was 2.62 hours and decreased to 1.47 hours post-protocol. Neonates fully admitted within the golden hour, represented by the closure of the isolette top, increased from 7% pre-protocol to 20% post-protocol. These results suggest that implementation of a GH Protocol increases the efficiency of admissions for premature neonates less than 33 weeks gestation.
Implications for practice: A standardized GH Protocol can lead to increased efficiency in admissions of premature infants less than 33 weeks gestation or identified VLBW.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University